Clinical Appropriateness Guidelines: Percutaneous Coronary Intervention
|
|
- Naomi Rachel Shields
- 5 years ago
- Views:
Transcription
1 Clinical Appropriateness Guidelines: Percutaneous Coronary Intervention Appropriate Use Criteria Effective Date: March 9, 2019 Proprietary Date of Origin: 08/27/2015 Last revised: 02/01/2018 Last reviewed: 03/01/2018 Copyright AIM Specialty Health. All Rights Reserved 8600 W Bryn Mawr Avenue South Tower - Suite 800 Chicago, IL P
2 Table of Contents Description and Application of the Guidelines...3 General Clinical Guideline...4 Percutaneous Coronary Intervention...6 Table of Contents Copyright AIM Specialty Health. All Rights Reserved. 2
3 Description and Application of the Guidelines AIM s Clinical Appropriateness Guidelines (hereinafter AIM s Clinical Appropriateness Guidelines or the Guidelines ) are designed to assist providers in making the most appropriate treatment decision for a specific clinical condition for an individual. As used by AIM, the Guidelines establish objective and evidence-based, where possible, criteria for medical necessity determinations. In the process, multiple functions are accomplished: To establish criteria for when services are medically necessary To assist the practitioner as an educational tool To encourage standardization of medical practice patterns To curtail the performance of inappropriate and/or duplicate services To advocate for patient safety concerns To enhance the quality of healthcare To promote the most efficient and cost-effective use of services AIM s guideline development process complies with applicable accreditation standards, including the requirement that the Guidelines be developed with involvement from appropriate providers with current clinical expertise relevant to the Guidelines under review and be based on the most up to date clinical principles and best practices. Relevant citations are included in the References section attached to each Guideline. AIM reviews all of its Guidelines at least annually. AIM makes its Guidelines publicly available on its website twenty-four hours a day, seven days a week. Copies of AIM s Clinical Appropriateness Guidelines are also available upon oral or written request. Although the Guidelines are publicly-available, AIM considers the Guidelines to be important, proprietary information of AIM, which cannot be sold, assigned, leased, licensed, reproduced or distributed without the written consent of AIM. AIM applies objective and evidence-based criteria and takes individual circumstances and the local delivery system into account when determining the medical appropriateness of health care services. The AIM Guidelines are just guidelines for the provision of specialty health services. These criteria are designed to guide both providers and reviewers to the most appropriate services based on a patient s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice should be used when applying the Guidelines. Guideline determinations are made based on the information provided at the time of the request. It is expected that medical necessity decisions may change as new information is provided or based on unique aspects of the patient s condition. The treating clinician has final authority and responsibility for treatment decisions regarding the care of the patient and for justifying and demonstrating the existence of medical necessity for the requested service. The Guidelines are not a substitute for the experience and judgment of a physician or other health care professionals. Any clinician seeking to apply or consult the Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient s care or treatment. The Guidelines do not address coverage, benefit or other plan specific issues. Applicable federal and state coverage mandates take precedence over these clinical guidelines. If requested by a health plan, AIM will review requests based on health plan medical policy/guidelines in lieu of AIM s Guidelines. The Guidelines may also be used by the health plan or by AIM for purposes of provider education, or to review the medical necessity of services by any provider who has been notified of the need for medical necessity review, due to billing practices or claims that are not consistent with other providers in terms of frequency or some other manner. CPT (Current Procedural Terminology) is a registered trademark of the American Medical Association (AMA). CPT five digit codes, nomenclature and other data are copyright by the American Medical Association. All Rights Reserved. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein. Guideline Description and General Clinical Guideline Copyright AIM Specialty Health. All Rights Reserved. 3
4 General Clinical Guideline Clinical Appropriateness Framework Critical to any finding of clinical appropriateness under the guidelines for a specific diagnostic or therapeutic intervention are the following elements: Prior to any intervention, it is essential that the clinician confirm the diagnosis or establish its pretest likelihood based on a complete evaluation of the patient. This includes a history and physical examination and, where applicable, a review of relevant laboratory studies, diagnostic testing, and response to prior therapeutic intervention. The anticipated benefit of the recommended intervention should outweigh any potential harms that may result (net benefit). Current literature and/or standards of medical practice should support that the recommended intervention offers the greatest net benefit among competing alternatives. Based on the clinical evaluation, current literature, and standards of medical practice, there exists a reasonable likelihood that the intervention will change management and/or lead to an improved outcome for the patient. If these elements are not established with respect to a given request, the determination of appropriateness will most likely require a peer-to-peer conversation to understand the individual and unique facts that would supersede the requirements set forth above. During the peer-to-peer conversation, factors such as patient acuity and setting of service may also be taken into account. Simultaneous Ordering of Multiple Diagnostic or Therapeutic Interventions Requests for multiple diagnostic or therapeutic interventions at the same time will often require a peer-to-peer conversation to understand the individual circumstances that support the medical necessity of performing all interventions simultaneously. This is based on the fact that appropriateness of additional intervention is often dependent on the outcome of the initial intervention. Additionally, either of the following may apply: Current literature and/or standards of medical practice support that one of the requested diagnostic or therapeutic interventions is more appropriate in the clinical situation presented; or One of the diagnostic or therapeutic interventions requested is more likely to improve patient outcomes based on current literature and/or standards of medical practice. Repeat Diagnostic Intervention In general, repeated testing of the same anatomic location for the same indication should be limited to evaluation following an intervention, or when there is a change in clinical status such that additional testing is required to determine next steps in management. At times, it may be necessary to repeat a test using different techniques or protocols to clarify a finding or result of the original study. Repeated testing for the same indication using the same or similar technology may be subject to additional review or require peer-to-peer conversation in the following scenarios: Repeated diagnostic testing at the same facility due to technical issues Repeated diagnostic testing requested at a different facility due to provider preference or quality concerns Repeated diagnostic testing of the same anatomic area based on persistent symptoms with no clinical change, treatment, or intervention since the previous study Repeated diagnostic testing of the same anatomic area by different providers for the same member over a short period of time Repeat Therapeutic Intervention In general, repeated therapeutic intervention in the same anatomic area is considered appropriate when the prior intervention proved effective or beneficial and the expected duration of relief has lapsed. A repeat intervention requested prior to the expected duration of relief is not appropriate unless it can be confirmed that the prior intervention was never administered. Guideline Description and General Clinical Guideline Copyright AIM Specialty Health. All Rights Reserved. 4
5 General Clinical Guideline History Status Date Action Revised 03/09/2019 Retitled Pretest Requirements to Clinical Appropriateness Framework to summarize the components of a decision to pursue diagnostic testing. To expand applicability beyond diagnostic imaging, retitled Ordering of Multiple Studies to Simultaneous Ordering of Multiple Diagnostic or Therapeutic Interventions and replaced imaging-specific terms with diagnostic or therapeutic intervention. Repeated Imaging split into two subsections, repeat diagnostic intervention and repeat therapeutic intervention. Reviewed 07/11/2018 Last Independent Multispecialty Physician Panel review Revised 07/26/2016 Independent Multispecialty Physician Panel revised Created 03/30/2005 Original effective date Guideline Description and General Clinical Guideline Copyright AIM Specialty Health. All Rights Reserved. 5
6 Percutaneous Coronary Intervention (PCI) CPT Codes Percutaneous transluminal coronary angioplasty; single major coronary artery or branch Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure) Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure) Scope of this Guideline Emergency percutaneous coronary intervention (PCI) is used for management of acute coronary syndromes (ST segment elevation myocardial infarction, non-st elevation myocardial infarction, or unstable angina pectoris). PCI for the management of stable ischemic heart disease (SIHD) is considered to be elective and is the focus of this document. Percutaneous Coronary Intervention Copyright AIM Specialty Health. All Rights Reserved. 6
7 Guideline Interpretation This guideline does not supersede the enrollee s health plan medical policy specific to PCI. PCI may include any or all of the following: balloon angioplasty, coronary stent placement, or coronary atherectomy. Specific procedure selection is at the discretion of the operating physician. The term PCI applies to intervention on both native coronary arteries and coronary bypass grafts (both arterial and venous). Determination of the appropriateness of PCI requires knowledge of the results of diagnostic coronary arteriography. In determination of the degree of angiographic disease, this guideline observes the following definition of significant coronary stenosis: > or = 50% left main stenosis, > or = 70% nonleft main stenosis, or 40%-69% stenosis of an epicardial vessel with fractional flow reserve (FFR) < or = 0.8 (measured at angiography). Frequently, PCI is performed at the same sitting as diagnostic coronary arteriography. Although there is sometimes clinical justification to separate the two procedures, separate procedures based on facility operational requirements should be avoided wherever possible. In some clinical situations, coronary artery bypass grafting (CABG) may be considered as an alternative to PCI as a method revascularization. Although the literature addresses the relative indications for PCI versus CABG for populations of patients, it is recognized that clinical characteristics and choices of individual patients must also be considered. Elective PCI has not been shown to be superior to optimal medical therapy for patients with stable angina pectoris. Therefore every effort should be made to optimize medical therapy before consideration of PCI. Currently, evidence supporting use of PCI in asymptomatic patients with stable CAD is lacking. Therefore, PCI is generally reserved for symptomatic patients because, while PCI has been shown to reduce symptoms, reduction in incidence of myocardial infarction or mortality has not been demonstrated. Although the risk-benefit ratio for any procedure should dictate clinical appropriateness on a case-by-case basis, advanced age, advanced renal disease, advanced malignancy or coagulopathy should be considered relative contraindications to PCI. Providers who refer patients for PCI and those who perform such procedures are responsible for considering safety issues. In particular, the requirement for intravascular iodinated contrast material, which may have an adverse effect on patients with a history of documented allergic contrast reactions or atopy, as well as on individuals with renal impairment, who are at greater risk for contrast-induced nephropathy. Since PCI requires the use of fluoroscopy, it is critically important that every effort be made to minimize exposure of the patient and the laboratory staff to ionizing radiation. References to Fractional Flow Reserve (FFR) in this document should be interpreted as invasively measured FFR. It is assumed that all patients with SIHD will be treated with secondary prevention therapies (antihypertensives, lipid lowering agents, antidiabetic agents, antiplatelet agents, etc.) where indicated. In addition, patients with symptomatic SIHD should receive antianginal medications (e.g. beta blockers, calcium channel blockers, long-acting nitrate preparations, ranolazine). For the purposes of this guideline, a patient is considered to be taking an antianginal agent if (s)he (a) is currently taking the medication at the maximally tolerated dose, (b) is intolerant of the medication or (c) has a contraindication to that class of medications. In clinical scenarios where appropriateness of PCI is based on findings at noninvasive testing, only testing performed since the most recent revascularization procedure (PCI or CABG) should be considered. Percutaneous Coronary Intervention Copyright AIM Specialty Health. All Rights Reserved. 7
8 Table 1: Noninvasive Risk Stratification* High risk (>3% annual death or MI) 1. Severe resting LV dysfunction (LVEF <35%) not readily explained by noncoronary causes 2. Resting perfusion abnormalities > or =10% of the myocardium in patients without prior history or evidence of MI 3. Stress ECG findings including > or =2 mm of ST-segment depression at low workload or persisting into recovery, exercise-induced ST-segment elevation, or exercise-induced VT/VF 4. Severe stress-induced LV dysfunction (peak exercise LVEF <45% or drop in LVEF with stress > or =10%) 5. Stress-induced perfusion abnormalities encumbering > or =10% myocardium or stress segmental scores indicating multiple vascular territories with abnormalities 6. Stress-induced LV dilation 7. Inducible wall motion abnormality (involving >2 segments or 2 coronary beds) 8. Wall motion abnormality developing at low dose of dobutamine (< or =10 mg/kg/min) or at a low heart rate (<120 beats/min) 9. CAC score >400 Agatston units 10. Multivessel obstructive CAD (> or =70% stenosis) or left main stenosis (> or =50% stenosis) on CCTA Intermediate risk (1% to 3% annual death or MI) 1. Mild/moderate resting LV dysfunction (LVEF 35% to 49%) not readily explained by noncoronary causes 2. Resting perfusion abnormalities in 5% to 9.9% of the myocardium in patients without a history or prior evidence of MI 3. > or =1 mm of ST-segment depression occurring with exertional symptoms 4. Stress-induced perfusion abnormalities encumbering 5% to 9.9% of the myocardium or stress segmental scores (in multiple segments) indicating 1 vascular territory with abnormalities but without LV dilation 5. Small wall motion abnormality involving 1 to 2 segments and only 1 coronary bed 6. CAC score 100 to 399 Agatston units 7. One vessel CAD with > or =70% stenosis or moderate CAD stenosis (50% to 69% stenosis) in > or =2 arteries on CCTA Low risk (<1% annual death or MI) 1. Low-risk treadmill score (score > or =5) or no new ST segment changes or exercise-induced chest pain symptoms; when achieving maximal levels of exercise 2. Normal or small myocardial perfusion defect at rest or with stress encumbering <5% of the myocardium* 3. Normal stress or no change of limited resting wall motion abnormalities during stress 4. CAC score <100 Agatston units 5. No coronary stenosis >50% on CCTA * Although the published data are limited, patients with these findings will probably not be at low risk in the presence of either a high-risk treadmill score or severe resting LV dysfunction (LVEF <35%). CAC indicates coronary artery calcium; CAD, coronary artery disease; CCTA, coronary computed tomography angiography; LV, left ventricular; LVEF, left ventricular ejection fraction; and MI, myocardial infarction. Reproduced from Fihn SD, et al. J Am Coll Cardiol Percutaneous Coronary Intervention Copyright AIM Specialty Health. All Rights Reserved. 8
9 Indications for PCI in patients who have not undergone CABG The following indications for elective PCI are accompanied by pre-test considerations as well as supporting clinical data and prerequisite information. Patients with one vessel coronary artery disease Symptomatic patients who are receiving only one (1) antianginal medication and have Proximal involvement;* AND Intermediate or high-risk findings on noninvasive testing * Proximal involvement refers to involvement of the proximal LAD or of a dominant circumflex vessel. Symptomatic patients who are receiving maximal antianginal medical therapy and have Abnormal noninvasive testing; OR No noninvasive testing since symptom onset and FFR < or = 0.8; OR Inconclusive noninvasive testing since symptom onset and FFR < or = 0.8 Patients with two vessel coronary artery disease Symptomatic patients who are receiving only one (1) antianginal medication and have Intermediate or high-risk findings on noninvasive testing; OR No noninvasive testing since symptom onset and FFR < or = 0.8; OR Inconclusive noninvasive testing since symptom onset and FFR < or = 0.8 Symptomatic non-diabetic patients who are receiving no antianginal medication and have Proximal involvement #; AND Intermediate or high-risk findings on noninvasive testing # Proximal involvement refers to involvement of the proximal LAD. Symptomatic patients who are receiving maximal antianginal medical therapy and have Abnormal noninvasive testing; OR No noninvasive testing since symptom onset and FFR < or = 0.8; OR Inconclusive noninvasive testing since symptom onset and FFR < or = 0.8 Patients with three vessel coronary artery disease Symptomatic patients who are receiving maximal antianginal medical therapy and have Low disease complexity (e.g. focal stenosis, SYNTAX score < or = 22) Symptomatic patients who are receiving only one (1) antianginal medication and have Low disease complexity (e.g. focal stenosis, SYNTAX score < or = 22); AND Intermediate or high-risk findings on noninvasive testing Symptomatic non-diabetic patients who are receiving no antianginal medication and have Low disease complexity (e.g. focal stenosis, SYNTAX score < or = 22); AND Intermediate or high-risk findings on noninvasive testing Percutaneous Coronary Intervention Copyright AIM Specialty Health. All Rights Reserved. 9
10 Patients with left main coronary artery disease Patients who are taking any antianginal therapy and who meet all of the following criteria Ischemic symptoms Disease does not involve the LM bifurcation There is no significant CAD in other coronary arteries or (if other disease is present) SYNTAX score is < or = 22 Patients who are not taking any antianginal therapy and who meet all of the following criteria Ischemic symptoms Disease does not involve the LM bifurcation There is no significant CAD in other coronary arteries Indications for PCI in patients who have undergone CABG Patients with a patent internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery who are receiving only one (1) antianginal medication and meet all of the following criteria Ischemic symptoms Stenosis(es) in a native vessel(s) or bypass graft(s) supplying one (1) or two (2) vascular territories (other than the LAD) Intermediate or high-risk findings on noninvasive testing* * If noninvasive testing has not been performed or is indeterminate, FFR < or = 0.8 will substitute for this requirement. Patients with a patent internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery who are receiving maximal antianginal therapy and who meet all of the following criteria Ischemic symptoms Abnormal (low, intermediate or high-risk findings) on noninvasive testing* Stenosis(es) in a native vessel(s) or bypass graft(s) supplying one (1) or two (2) vascular territories (other than the LAD) * If noninvasive testing has not been performed or is indeterminate, FFR < or = 0.8 will substitute for this requirement. Patients with a non-patent internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery who are not taking any antianginal therapy, have intermediate or high-risk findings on noninvasive testing* and meet either of the following criteria Have ischemic symptoms and stenosis(es) in a native vessel(s) or bypass graft(s) supplying two (2) or three (3) vascular territories (including the LAD) Have no ischemic symptoms and stenosis(es) in a native vessel(s) or bypass graft(s) supplying three (3) vascular territories (including the LAD) * If noninvasive testing has not been performed or is indeterminate, FFR < or = 0.8 will substitute for this requirement. Symptomatic patients with a non-patent internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery who are receiving only one (1) antianginal medication and meet one of the following criteria Stenosis(es) in a native vessel(s) or bypass graft(s) supplying only the LAD territory and intermediate or high-risk findings on noninvasive testing* Stenosis(es) in a native vessel(s) or bypass graft(s) supplying two (2) vascular territories (including the LAD) and abnormal (low, intermediate or high-risk findings) on noninvasive testing* Stenosis(es) in a native vessel(s) or bypass graft(s) supplying three (3) vascular territories (including the LAD) and intermediate or high-risk findings on noninvasive testing* * If noninvasive testing has not been performed or is indeterminate, FFR < or = 0.8 will substitute for this requirement. Percutaneous Coronary Intervention Copyright AIM Specialty Health. All Rights Reserved. 10
11 Patients with a non-patent internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery who are receiving maximal antianginal therapy and who meet all of the following criteria Ischemic symptoms Abnormal (low, intermediate or high-risk findings) on noninvasive testing* * If noninvasive testing has not been performed or is indeterminate, FFR < or = 0.8 will substitute for this requirement. Other scenarios Scheduled to undergo percutaneous valvular procedures (e.g. TAVR/TAVI or mitral repair) when any of the following applies Left main or triple vessel CAD One (1) or two (2) vessel CAD and intermediate or high-risk findings on noninvasive testing One (1) or two (2) vessel CAD with proximal LAD involvement, low-risk findings on noninvasive testing and ischemic symptoms despite any antianginal therapy One (1) or two (2) vessel CAD without proximal LAD involvement, low-risk findings on noninvasive testing and ischemic symptoms despite maximal antianginal therapy Scheduled to undergo renal transplantation when any of the following applies and SYNTAX score is < or = 22 Persistent symptoms despite maximal antianginal therapy Persistent symptoms despite any antianginal therapy in non-diabetic patients with intermediate or high-risk findings on noninvasive testing Ischemic symptoms in non-diabetic patients who are not taking any antianginal therapy and have left main disease, triple vessel disease, or proximal LAD disease, with intermediate or high-risk findings on noninvasive testing References 1. Boden WE, O Rourke RA, Teo KK, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356(15): Dagenais GR, Lu J, Faxon DP, et al; Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group. Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularizations in patients with type II diabetes mellitus and stable ischemic heart disease. Circulation. 2011; 123(14): De Bruyne B, Pijls NH, Kalesan B, et al; FAME 2 Trial Investigators. Fractional flow reserve guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367(11): Diamond GA. A clinically relevant classification of chest discomfort. J Am Coll Cardiol. 1983; 1(2 Pt 1): Fihn SD, Blankenship JC, Alexander KP, et al ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18): Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60(24):e44 e Kappetein AP, Feldman TE, Mack MJ, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J. 2011;32(17):2125 Percutaneous Coronary Intervention Copyright AIM Specialty Health. All Rights Reserved. 11
12 King SB 3rd, Barnhart HX, Kosinski AS, et al. Emory Angioplasty versus Surgery Trial Investigators. Angioplasty or surgery for multivessel coronary artery disease: comparison of eligible registry and randomized patients in the EAST trial and influence of treatment selection on outcomes. Am J Cardiol. 1997;79(11): Levine GN, Bates ER, Blankenship JC, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions ACCF/AHA/ SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44-e Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients with Stable Ischemic Heart Disease: a Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69(17): Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update: a Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2012;59(9): Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA; et al. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology. J Am Coll Cardiol. 2009;53(6): Pursnani S, Korley F, Gopaul R, et al. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Circ Cardiovasc Interv. 2012;5(4): Task Force Members, Montalescot G, Sechtem U, Achenbach S, et al ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013; 34(38): Percutaneous Coronary Intervention Copyright AIM Specialty Health. All Rights Reserved. 12
Clinical Appropriateness Guidelines: Percutaneous Coronary Intervention
Clinical Appropriateness Guidelines: Percutaneous Coronary Intervention Appropriate Use Criteria Effective Date: January 2, 2018 Proprietary Date of Origin: 08/27/2015 Last revised: 08/01/2017 Last reviewed:
More informationClinical Appropriateness Guidelines: Diagnostic Coronary Angiography
Clinical Appropriateness Guidelines: Diagnostic Coronary Angiography Appropriate Use Criteria Effective Date: January 2, 2018 Proprietary Date of Origin: 08/27/2015 Last revised: 02/23/2017 Last reviewed:
More informationClinical Appropriateness Guidelines: Advanced Imaging
Clinical Appropriateness Guidelines: Advanced Imaging Appropriate Use Criteria: Quantitative CT (QCT) Bone Mineral Densitometry Effective Date: September 5, 2017 Proprietary Date of Origin: 05/21/2007
More informationStable Angina: Indication for revascularization and best medical therapy
Stable Angina: Indication for revascularization and best medical therapy Cardiology Basics and Updated Guideline 2018 Chang-Hwan Yoon, MD/PhD Cardiovascular Center, Department of Internal Medicine Bundang
More informationClinical Appropriateness Guidelines: Advanced Imaging
Clinical Appropriateness Guidelines: Advanced Imaging Appropriate Use Criteria: Imaging of Bone Marrow Blood Supply Effective Date: September 5, 2017 Proprietary Date of Origin: 05/21/2007 Last revised:
More informationCoronary Artery Disease: Revascularization (Teacher s Guide)
Stephanie Chan, M.D. Updated 3/15/13 2008-2013, SCVMC (40 minutes) I. Objectives Coronary Artery Disease: Revascularization (Teacher s Guide) To review the evidence on whether percutaneous coronary intervention
More informationCase Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)?
Cronicon OPEN ACCESS CARDIOLOGY Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Valentin Hristov* Department of Cardiology, Specialized
More informationImaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD Hein J. Verberne Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands International Conference
More informationDESCRIPTION: Percentage of patients aged 18 years and older undergoing isolated CABG surgery who received an IMA graft
Measure #43 (NQF 0134): Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS
More informationJournal of the American College of Cardiology Vol. 35, No. 5, by the American College of Cardiology ISSN /00/$20.
Journal of the American College of Cardiology Vol. 35, No. 5, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00546-5 CLINICAL
More informationSacroiliac Joint Fusion
Cover Sacroiliac Joint Fusion Musculoskeletal Program Clinical Appropriateness Guidelines Sacroiliac Joint Fusion EFFECTIVE JULY 01, 2018 LAST REVIEWED DECEMBER 12, 2017 Appropriate.Safe.Affordable 2018
More informationCLINICAL SYMPTOMS AND ANGIOGRAPHIC FINDINGS OF PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY WITHOUT PRIOR STRESS TESTING. Mouin S.
CLINICAL SYMPTOMS AND ANGIOGRAPHIC FINDINGS OF PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY WITHOUT PRIOR STRESS TESTING BY Mouin S. Abdallah Submitted to the graduate degree program in Clinical research
More informationFractional Flow Reserve (FFR) Shown to Improve Patient Outcomes and Reduce Costs. Executive Summary
(FFR) Shown to Improve Patient Outcomes and Reduce s Keywords Fractional Flow Reserve, coronary artery disease, stenosis, blood flow blockages Published: 5 October 213 Citation: RadcliffeCardiology.com,
More informationStable Ischemic Heart Disease. Ivan Anderson, MD RIHVH Cardiology
Stable Ischemic Heart Disease Ivan Anderson, MD RIHVH Cardiology Outline Review of the vascular biology of atherosclerosis Why not just cath everyone with angina? Medical management of ischemic cardiomyopathy
More informationCPT Code Details
CPT Code 93572 Details Code Descriptor Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically
More informationManagement of stable CAD FFR guided therapy: the new gold standard
Management of stable CAD FFR guided therapy: the new gold standard Suleiman Kharabsheh, MD Director; CCU, Telemetry and CHU Associate professor of Cardiology, Alfaisal Univ. KFHI - KFSHRC Should patients
More informationDetailed Order Request Checklists for Cardiology
Next Generation Solutions Detailed Order Request Checklists for Cardiology 8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 www.aimspecialtyhealth.com Appropriate.Safe.Affordable 2018
More informationEvidence-Based Management of CAD: Last Decade Trials and Updated Guidelines
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines Enrico Ferrari, MD Cardiac Surgery Unit Cardiocentro Ticino Foundation Lugano, Switzerland Conflict of Interests No conflict
More information2017 Cardiology Survival Guide
2017 Cardiology Survival Guide Chapter 4: Cardiac Catheterization/Percutaneous Coronary Intervention A cardiac catheterization involves a physician inserting a thin plastic tube (catheter) into an artery
More informationBenefit of Performing PCI Based on FFR
Benefit of Performing PCI Based on FFR William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center Benefit of FFR-Guided PCI FFR-Guided PCI vs. Angiography-Guided
More informationFFR Incorporating & Expanding it s use in Clinical Practice
FFR Incorporating & Expanding it s use in Clinical Practice Suleiman Kharabsheh, MD Consultant Invasive Cardiology Assistant professor, Alfaisal Univ. KFHI - KFSHRC Concept of FFR Maximum flow down a vessel
More informationPCIs on Intermediate Lesions NCDR Cath-PCI Registry
Practical Application Of Coronary Physiology in The Cath Lab Talal T Attar, MD, MBA, FACC PCIs on Intermediate Lesions NCDR Cath-PCI Registry Fraction of stenoses 50-70% treated with PCI without further
More informationFFR in Multivessel Disease
FFR in Multivessel Disease April, 26 2013 Coronary Physiology in the Catheterization Laboratory Location: European Heart House, Nice, France Pim A.L. Tonino, MD, PhD Hartcentrum, Eindhoven, the Netherlands
More informationIndications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such
More information2/17/2010. Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco
Modern Management of Patients with Stable Coronary Artery Disease Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco Scope of the Problem Prevalence of CAD: 17.6 million
More informationWhat do the guidelines say?
Percutaneous coronary intervention in 3-vessel disease and main stem What do the guidelines say? Nothing to disclose Dariusz Dudek Institute of Cardiology, Jagiellonian University Krakow, Poland The European
More informationDebate Should we use FFR? I will say NO.
Debate Should we use FFR? I will say NO. Hyeon-Cheol Gwon Cardiac and Vascular Center Samsung Medical Center Sungkyunkwan University School of Medicine Dr. Hyeon-Cheol Gwon Research fund from Abbott Korea
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Efficiency
Quality ID #323: Cardiac Stress Imaging t Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI) National Quality Strategy Domain: Efficiency and Cost Reduction
More informationCan Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
More informationCardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology
Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations
More informationb. To facilitate the management decision of a patient with an equivocal stress test.
National Imaging Associates, Inc. Clinical guidelines EBCT HEART CT & HEART CT CONGENITAL CCTA CPT4 Codes: 75571 EBCT 75572, 75573 Heart CT & Heart CT Congenital 75574 - CCTA LCD ID Number: L33559 J K
More informationPremier Health Plan considers Intravascular Ultrasound (IVUS) for Coronary Vessels medically necessary for the following indications:
Premier Health Plan POLICY AND PROCEDURE MANUAL MP.091.PH - Intravascular Ultrasound for Coronary Vessels This policy applies to the following lines of business: Premier Commercial Premier Employee Premier
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
Measure #323: Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI) National Quality Strategy Domain: Efficiency and Cost Reduction
More informationFractional Flow Reserve: Basics, FAME 1, FAME 2. William F. Fearon, MD Associate Professor Stanford University Medical Center
Fractional Flow Reserve: Basics, FAME 1, FAME 2 William F. Fearon, MD Associate Professor Stanford University Medical Center Conflict of Interest Advisory Board for HeartFlow Research grant from St. Jude
More informationI have no financial disclosures
Manpreet Singh MD I have no financial disclosures Exercise Treadmill Bicycle Functional capacity assessment Well validated prognostic value Ischemic assessment ECG changes ST segments Arrhythmias Hemodynamic
More informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
More informationZachary I. Hodes, M.D., Ph.D., F.A.C.C.
Zachary I. Hodes, M.D., Ph.D., F.A.C.C. Disclamer: I personally have no financial relationship with any company mentioned today. The Care Group, LLC does have a contract with Cardium to participate in
More informationTiming of Surgery After Percutaneous Coronary Intervention
Timing of Surgery After Percutaneous Coronary Intervention Deepak Talreja, MD, FACC Bayview/EVMS/Sentara Outline/Highlights Timing of elective surgery What to do with medications Stopping anti-platelet
More informationManagement of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018
Management of Stable Ischemic Heart Disease Vinay Madan MD February 10, 2018 1 Disclosure No financial disclosure. 2 Overview of SIHD Diagnosis Outline of talk Functional vs. Anatomic assessment Management
More informationCLINICAL CONSEQUENCES OF THE
CLINICAL CONSEQUENCES OF THE FAME STUDY TCT ASIA Seoul, Korea, april 26 th, 2012 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands GUIDELINES ESC SEPTEMBER 2010 FFR UPGRADED TO LEVEL
More informationFractional Flow Reserve. A physiological approach to guide complex interventions
Fractional Flow Reserve A physiological approach to guide complex interventions What is FFR? Fractional Flow Reserve (FFR) is a lesion specific, physiological index determining the hemodynamic severity
More informationΣεμινάριο Ομάδων Εργασίας Fractional Flow Reserve (FFR) Σε ποιούς ασθενείς; ΔΗΜΗΤΡΗΣ ΑΥΖΩΤΗΣ Επιστ. υπεύθυνος Αιμοδυναμικού Τμήματος, Βιοκλινική
ΕΛΛΗΝΙΚΗΚΑΡΔΙΟΛΟΓΙΚΗΕΤΑΙΡΕΙΑ Σεμινάριο Ομάδων Εργασίας 2011 Fractional Flow Reserve (FFR) Σε ποιούς ασθενείς; ΔΗΜΗΤΡΗΣ ΑΥΖΩΤΗΣ Επιστ. υπεύθυνος Αιμοδυναμικού Τμήματος, Βιοκλινική GUIDELINES ON MYOCARDIAL
More informationFFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium
FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium Conflict of Interest Institutional research grants and speaker s fee from St. Jude Medical and Boston Scientic to Cardiovascular
More informationSupplementary Material to Mayer et al. A comparative cohort study on personalised
Suppl. Table : Baseline characteristics of the patients. Characteristic Modified cohort Non-modified cohort P value (n=00) Age years 68. ±. 69.5 ±. 0. Female sex no. (%) 60 (0.0) 88 (.7) 0.0 Body Mass
More information2019 ABBOTT REIMBURSEMENT GUIDE CMS Physician Fee Schedule
ABBOTT REIMBURSEMENT GUIDE CMS Physician Fee Schedule This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement,
More informationΔημήτριος Αγγοσράς, FETCS
ΣΕΜΙΝΑΡΙΟ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ Δημήτριος Αγγοσράς, FETCS Επίκοσρος Καθηγηηής Καρδιοτειροσργικής Ιαηρική Πανεπιζηημίοσ Αθηνών Πανεπιζηημιακό Γενικό Νοζοκομείο Αηηικόν Randomized Controlled Trials (RCTs) Why
More informationMEDICAL POLICY No R1 COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY CORONARY ARTERIES (CCTA)
COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY CONARY ARTERIES (CCTA) Effective Date: June 19, 2017 Review Dates: 11/15, 11/16 Date Of Origin: November 11, 2015 Status: Current Summary of Changes Clarifications:
More informationFFR vs. icecg in Coronary Bifurcations (FIESTA) - preliminary results. Dobrin Vassilev MD, PhD National Heart Hospital Sofia, Bulgaria
FFR vs. icecg in Coronary Bifurcations (FIESTA) - preliminary results Dobrin Vassilev MD, PhD National Heart Hospital Sofia, Bulgaria I would like to express my personal gratitude to Dr. BK Koo for opening
More informationMy Patient Needs a Stress Test
My Patient Needs a Stress Test Amy S. Burhanna,, MD, FACC Coastal Cardiology Cape May Court House, New Jersey Absolute and relative contraindications to exercise testing Absolute Acute myocardial infarction
More informationControversies in Cardiac Surgery
Controversies in Cardiac Surgery 3 years after SYNTAX : Percutaneous Coronary Intervention for Multivessel / Left main stem Coronary artery disease Pro ESC Congress 2010, 28 August 1 September Stockholm
More informationFractional Flow Reserve: Review of the latest data
Fractional Flow Reserve: Review of the latest data Michalis Hamilos, MD, PhD, FESC University Hospital of Heraklion Fractional Flow Reserve (FFR) Coronary angiography does not always tell the truth Most
More informationMEDICAL POLICY No R2 COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY CORONARY ARTERIES (CCTA)
COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY CONARY ARTERIES (CCTA) Effective Date: January 1, 2018 Review Dates: 11/15, 11/16, 11/17 Date Of Origin: November 11, 2015 Status: Current Summary of Changes Clarifications:
More informationCoronary interventions
Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF
More informationFFR vs icecg in Coronary Bifurcations FIESTA ClinicalTrials.gov Identifier: NCT
FFR vs icecg in Coronary Bifurcations FIESTA ClinicalTrials.gov Identifier: NCT01724957 Dobrin Vassilev MD, PhD Assoc. Prof. in Cardiology Head Cardiology Clinic, Alexandrovska University Hospital Medical
More informationSurgery Grand Rounds
Surgery Grand Rounds Coronary Artery Bypass Grafting versus Coronary Artery Stenting Charles Ted Lord, R1 Coronary Artery Disease Stenosis of epicardial vessels Metabolic & hematologic Statistics 500,000
More informationControversies in Coronary Revascularization. Atlanta CCU April 15, 2016
Controversies in Coronary Revascularization Atlanta CCU April 15, 2016 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology, Emory University Director, Cardiac Catheterization
More informationPeripheral and Cardiology Coder 2018
Peripheral and Cardiology Coder 2018 Cardiovascular Services and Procedures Prepared and Published By: MedLearn Publishing A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN
More informationScreening for Asymptomatic Coronary Artery Disease: When, How, and Why?
Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Joseph S. Terlato, MD FACC Clinical Assistant Professor, Brown Medical School Coastal Medical Definition The presence of objective
More informationFRACTIONAL FLOW RESERVE: STANDARD OF CARE
FRACTIONAL FLOW RESERVE: FROM INVESTIGATIONAL TOOL TO STANDARD OF CARE TCT ASIA Seoul, Korea, april 26 th, 2012 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands FRACTIONAL FLOW
More informationDavid A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine The Ohio State University Division of Cardiovascular Medicine Columbus, Ohio
1 STABLE ISCHEMIC HEART DISEASE: A NON-INVASIVE CARDIOLOGIST S PERSECTIVE 2018 Cardiovascular Course for Trainees and Early Career Physicians APRIL 20, 2018 David A. Orsinelli, MD, FACC, FASE Professor,
More informationTHERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE: 1) Patients who are 18 years and older with a diagnosis of CAD with LVEF < 40%
Quality ID #118 (NQF 0066): Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction
More informationMICHIGAN CORONARY CTA PRIOR-AUTHORIZATION INFORMATIONAL GUIDE
Payer BlueCross BlueShield Michigan Priority Health Health Alliance Plan of Michigan Policy Name Clinical Appropriateness Guidelines: Computerized Tomographic Angiography Coronary evicore Cardiac Imaging
More informationLocal Coverage Determination (LCD) for Cardiac Catheterization (L29090)
Local Coverage Determination (LCD) for Cardiac Catheterization (L29090) Contractor Information Contractor Name First Coast Service Options, Inc. Contractor Number 09102 Contractor Type MAC - Part B LCD
More informationLM stenting - Cypher
LM stenting - Cypher Left main stenting with BMS Since 1995 Issues in BMS era AMC Restenosis and TLR (%) 3 27 TLR P=.282 Restenosis P=.71 28 2 1 15 12 Ostium 5 4 Shaft Bifurcation Left main stenting with
More informationStable coronary artery disease: clinical case analysis according to esc and ACC/AHA guidelines (ESC 2013, ACC/AHA 2012 and focused update 2014)
10 Srce i krvni sudovi 2016; 35(1): 10-14 Case report UDRUŽENJE KARDIOLOGA SRBIJE CARDIOLOGY SOCIETY OF SERBIA Stable coronary artery disease: clinical case analysis according to esc and ACC/AHA guidelines
More informationVCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital
VCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital Complex PCI: Multivessel Disease George W. Vetrovec, MD. Kimmerling Chair of Cardiology VCU Pauley Heart Center Virginia
More informationCOURAGE to Leave Diseased Arteries Alone
COURAGE to Leave Diseased Arteries Alone Spencer King MD MACC, FSCAI St. Joseph s s Heart and Vascular Institute Professor of Medicine Emeritus Emory Univ. Atlanta, USA Conflict: I am an Interventionalist
More informationMEDICAL POLICY SUBJECT: TRANSMYOCARDIAL REVASCULARIZATION
MEDICAL POLICY SUBJECT: TRANSMYOCARDIAL 7/21/05, 05/18/06, 03/15/07, 02/21/08,, PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply.
More informationClinical Policy Title: Brachytherapy of coronary arteries
Clinical Policy Title: Brachytherapy of coronary arteries Clinical Policy Number: 04.02.04 Effective Date: January 1, 2016 Initial Review Date: September 16, 2015 Most Recent Review Date: October 19, 2017
More informationPerioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease
2012 대한춘계심장학회 Perioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease 울산의대울산대학병원심장내과이상곤 ECG CLASS IIb 1. Preoperative resting 12-lead ECG may be reasonable in patients with
More informationNovel insights into the complexity of ischaemic heart disease derived from combined coronary pressure and flow velocity measurements van de Hoef, T.P.
UvA-DARE (Digital Academic Repository) Novel insights into the complexity of ischaemic heart disease derived from combined coronary pressure and flow velocity measurements van de Hoef, T.P. Link to publication
More informationForm 4: Coronary Evaluation
Form : Coronary Evaluation Print this Form t Started Date of Coronary Evaluation Coronary Evaluation Indication for Coronary Evaluation Check only one. Angio NOT DONE: n invasive test performed Followup
More informationTreatment Options for Angina
Treatment Options for Angina Interventional Cardiology Perspective Michael A. Robertson, M.D. 10/30/10 Prevalence of CAD in USA 15 million Americans with CAD 2 million diagnostic catheterizations 1 million
More informationShould we be using fractional flow reserve more routinely to select stable coronary patients for percutaneous coronary intervention?
REVIEW C URRENT OPINION Should we be using fractional flow reserve more routinely to select stable coronary patients for percutaneous coronary intervention? Seung-Jung Park and Jung-Min Ahn Purpose of
More informationPatient referral for elective coronary angiography: challenging the current strategy
Patient referral for elective coronary angiography: challenging the current strategy M. Santos, A. Ferreira, A. P. Sousa, J. Brito, R. Calé, L. Raposo, P. Gonçalves, R. Teles, M. Almeida, M. Mendes Cardiology
More informationSurgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome
Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome Chris C. Cook, MD Associate Professor of Surgery Director, CT Residency Program, WVU ACOI 10/17/18 No Disclosures
More informationForm 4: Coronary Evaluation
Patient Details Hidden Show Show/Hide Annotations Form : Coronary Evaluation Print this Form t Started Date of Coronary Evaluation Coronary Evaluation Indication for Coronary Evaluation Check only one.
More informationCardiology for the Practitioner Advanced Cardiac Imaging: Worth the pretty pictures?
Keenan Research Centre Li Ka Shing Knowledge Institute Cardiology for the Practitioner Advanced Cardiac Imaging: Worth the pretty pictures? Howard Leong-Poi, MD, FRCPC Associate Professor of Medicine St.
More informationGuideline Number: NIA_CG_024 Last Review Date: January 2011 Responsible Department: Last Revised Date: May 2, 2011 Clinical Operations
National Imaging Associates, Inc. Clinical guidelines NUCLEAR CARDIAC IMAGING (MYOCARDIAL PERFUSION STUDY) CPT Codes: 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78481, 78483, 78494, 78499 Original
More informationCY2015 Hospital Outpatient: Endovascular Procedure APCs and Complexity Adjustments
CY2015 Hospital Outpatient: Endovascular Procedure APCs Complexity Adjustments Comprehensive Ambulatory Payment Classifications (c-apcs) CMS finalized the implementation of 25 Comprehensive APC to further
More informationCoronary microvascular dysfunction after elective percutaneous coronary intervention: correlation with exercise stress test results
Department of Cardiovascular Medicine Università Cattolica del Sacro Cuore Rome, Italy Coronary microvascular dysfunction after elective percutaneous coronary intervention: correlation with exercise stress
More informationAdvances in Cardiovascular Diagnosis and Therapy. No disclosure or conflicts. Outline
Advances in Cardiovascular Diagnosis and Therapy Firas Zahr, MD Assistant Professor of Medicine Interventional Cardiology University Of Iowa No disclosure or conflicts Outline What is new with revascularization?
More informationGuidelines/Appropriateness ARCH 2015 St Louis, Missouri April 9-11, 2015 Manish A. Parikh, MD, FACC,FSCAI
Guidelines/Appropriateness ARCH 2015 St Louis, Missouri April 9-11, 2015 Manish A. Parikh, MD, FACC,FSCAI Center for Interventional Vascular Therapy Columbia University Medical Center / New York Presbyterian
More informationJ. Schwitter, MD, FESC Section of Cardiology
J. Schwitter, MD, FESC Section of Cardiology CMR Center of the CHUV University Hospital Lausanne - CHUV Switzerland Centre de RM Cardiaque J. Schwitter, MD, FESC Section of Cardiology CMR Center of the
More informationCase Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA
Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA Case History A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour of midsternal chest pain that began after
More informationWhy have interventional cardiologists salaries
The New 2013 Coronary Intervention Codes As of January 1, 2013, coronary intervention codes in use since 1992 were replaced by new codes with new values for complex interventions. By James C. Blankenship,
More informationCORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW
CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW 2015 PQRS OPTIONS F MEASURES GROUPS: 2015 PQRS MEASURES IN CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP: #43 Coronary Artery Bypass Graft (CABG):
More informationDIAGNOSTIC TESTING IN PATIENTS WITH STABLE CHEST PAIN
DIAGNOSTIC TESTING IN PATIENTS WITH STABLE CHEST PAIN DISCLOSURES financial or pharmaceutical affiliations related to topic JOSHUA MESKIN, MD, FACC -Medical College of Wisconsin -Associate Professor of
More informationCorrective Surgery in Severe Heart Failure. Jon Enlow, D.O., FACS Cardiothoracic Surgeon Riverside Methodist Hospital, Ohiohealth Columbus, Ohio
Corrective Surgery in Severe Heart Failure Jon Enlow, D.O., FACS Cardiothoracic Surgeon Riverside Methodist Hospital, Ohiohealth Columbus, Ohio Session Objectives 1.) Identify which patients with severe
More informationRevascularization In HFrEF: Are We Close To The Truth. Ali Almasood
Revascularization In HFrEF: Are We Close To The Truth Ali Almasood HF epidemic 1-2% of the population have HF At least one-half have heart failure with reduced ejection fraction (HF- REF) The most common
More informationDo stents deserve the bad press? Mark A. Tulli MD, FACC
Do stents deserve the bad press? Mark A. Tulli MD, FACC Disclosures: None Introduction Stents don t help people. Stents are bad for patients. Heart Treatment Overused WSJ Study Finds Doctors Often Too
More informationMPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola
MPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola Nuclear Medicine Service, Asociacion Española Montevideo, Uruguay Quanta Diagnostico Nuclear Curitiba, Brazil Clinical history Male 63 y.o.,
More informationACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update
Journal of the American College of Cardiology Vol. 59, No. 9, 2012 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.12.001
More informationFractional Flow Reserve from Coronary CT Angiography (and some neat CT images)
Fractional Flow Reserve from Coronary CT Angiography (and some neat CT images) Victor Cheng, M.D. Director, Cardiovascular CT Oklahoma Heart Institute 1 Disclosures Tornadoes scare me 2 Treating CAD Fixing
More informationFFR-CT Not Ready for Primetime
FFR-CT Not Ready for Primetime Leslee J. Shaw, PhD, MASNC, FACC, FAHA, FSCCT R. Bruce Logue Professor of Medicine Co-Director, Emory Clinical CV Research Institute Emory University School of Medicine Atlanta,
More informationThe Role of Computed Tomography in the Diagnosis of Coronary Atherosclerosis
The Role of Computed Tomography in the Diagnosis of Coronary Atherosclerosis Saurabh Rajpal, MBBS, MD Assistant Professor Department of Internal Medicine Division of Cardiology The Ohio State University
More informationCase report. Resistance in the cath lab : the utility of hyperemic stenosis resistance in the functional assessment of coronary artery disease
Resistance in the cath lab : the utility of hyperemic stenosis resistance in the functional assessment of coronary artery disease Kalpa De Silva, Divaka Perera Cardiovascular Division, The Rayne Institute,
More informationTransmyocardial Revascularization
Protocol Transmyocardial Revascularization (70154) Medical Benefit Effective Date: 01/01/15 Next Review Date: 09/18 Preauthorization No Review Dates: 01/08, 01/09, 01/10, 01/11, 09/11, 09/12, 09/13, 09/14,
More informationClinical guideline Published: 23 July 2011 nice.org.uk/guidance/cg126
Stable angina: management Clinical guideline Published: 23 July 2011 nice.org.uk/guidance/cg126 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationOutpatient Cardiac Rehabilitation
Last Review Date: May 12, 2017 Number: MG.MM.ME.26bC3v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More information